KHẢ NĂNG TIÊN LƯỢNG NẶNG CỦA SIÊU ÂM Ở TRẺ SỐT XUẤT HUYẾT DENGUE CÓ DẤU HIỆU CẢNH BÁO TẠI BỆNH VIỆN NHI ĐỒNG CẦN THƠ

Abstract

Background: Dengue hemorrhagic fever is a mosquitoes vector-borne viral disease, causing ample serious complications such as shock which is due to plasma leakage. However, early detection and prediction of severe plasma leakage remains a challenge. Objectives: To describe the clinical and laboratory features, and identify prognostic factors for severity of ultrasound in dengue hemorrhagic fever with warning signs. Materials and methods: Cross-sectional study with analysis on 70 pediatric patients with dengue hemorrhagic fever with warning signs treated at Can Tho Children's Hospital from 2022-2024. Results: The average age was 11.3 years old, the shock group accounted for 42.9%, overweight/obese accounted for 25.7%. Main clinical symptoms: fever (100%), abdominal pain (76.7%), rash (68.6%), hepatomegaly >2cm (66.7%), and petechia and mucosal hemorrhage (55.7%). Laboratory features: median of platelet count was 37,500/mm³ and white blood cell count is 4510/mm³, mean of red blood cell volume is 43.4%. The incidence of ultrasound signs were: pleural effusion (27.1%), fluid in hepatorenal pouch of Morrison (31.4%), fluid in pouch of Douglas (30%), free abdominal fluid (45.7 %), fluid under the liver capsule (30%), hepatomegaly (67.1%), and gallbladder wall thickening (78.6%) with an average gallbladder wall thickness of 7.3mm. Among them, effusion at locations that can predict shock complications were the pleural cavity (OR=3.4, 95% CI=1.1-10.5, p=0.031), hepatorenal pouch of Morrison (OR=9.4, 95% CI=2.8-30.9, p=<0.001), pouch of Douglas (OR=8.7, 95% CI=2.6-29.3, p=<0.001), subcapsular liver (OR=3.0, 95% CI=1.18.8, p=0.04) and free abdominal fluid (OR=3.7, 95% CI=1.4-10.3, p=0.01). Conclusion: The role of some ultrasound imagings is significant in predicting severity in pediatric dengue hemorrhagic fever with warning signs.